ICU Cases of COVID-19 Paediatric Inflammatory Syndrome in the UK

Dawn O'Shea

July 17, 2020

Over a 6-week period, paediatric intensive care units (PICUs) throughout the UK admitted an average of 14 children per week with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), reaching a peak of 32 admissions per week.

The data come from a multicentre observational study of children (aged <18 years) admitted to PICUs in the UK between 1 April 2020 and 10 May 2020 fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health.

In total, 78 cases of PIMS-TS were reported by 21 of 23 PICUs. Compared with similar inflammatory conditions which had a mean of one admission per week, there were an average of 14 PIMS-TS admissions per week.

The median age of patients was 11 (interquartile range, 8-14) years. Male patients (67%) and those from ethnic minority backgrounds (78%) were over-represented.

Fever (100%), shock (87%), abdominal pain (62%), vomiting (63%) and diarrhoea (64%) were common presenting features.

Longitudinal data over the first four days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (from a median of 4030 μg/L to 1659 μg/L) and ferritin (from a median of 1042 μg/L to 757 μg/L). Lymphocyte count increased to more than 1.0×109 cells/L by day 3, and troponin increased over four days (from a median of 157 ng/mL to 358 ng/mL).

Thirty-six (46%) patients were invasively ventilated, and 83% needed vasoactive infusions. Almost three-quarters (73%) received steroids, 76 per cent received intravenous immunoglobulin and 22% received biologic therapies.

More than a third (36%) had evidence of coronary artery abnormalities (18 aneurysms and 10 echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died.

The authors say PIMS-TS might represent a post-COVID-19 immunological disease that is clinically distinct from acute COVID-19 in children.

Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, Johnson M, Griffiths B, du Pré P, Mohammad Z, Deep A, Playfor S, Singh D, Inwald D, Jardine M, Ross O, Shetty N, Worrall M, Sinha R, Koul A, Whittaker E, Vyas H, Scholefield BR, Ramnarayan P. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020 Jul 9 [Epub ahead of print]. doi: 10.1016/S2352-4642(20)30215-7. PMID: 32653054 Full text.

This article originally appeared on Univadis, part of the Medscape Professional Network.


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